HomeMy WebLinkAbout0881- --~s--~ --_ _- .
f OCK ~ ~ 2 .~ 273 ~ .
ST. LUCIE COUNTY. ALA.
Declcrotion of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ~ ASSESSOR,
3T . LUCIE COUNTY, FLORIDA : .
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of -___ Gaceen>NOOd._Iaka__Yillage._____..- ._, ________ ___.N.__Y.__-.____ .___._
(City) (~i;aie)
and I resided at r• ~' °~"`---~-~`'-- -__..__-.- -- . However, I have changed my domicile
lRtrewt and Number)
to and xm a.n.i ha.•p ticL.; a wo;;» ~d° rrsidont of f}hP StwtQ of FloridA since 2'/th day of
DECEMBER_ lg 60_ and I reside at Harmotlv__ HeiP_,hts_ Add,_ _~1_-Gen ;_ Dc~l._
_______
(Street and Number)
Ft . Pierce St . Lucie County Florida,
----------------
(City) -
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(lnaert here any pertinent facts, such ~as sale of property or business, or relinQuiabment of employment at
former domicile, removal of famih to new domicile, porchase of home. ete.)
C + ~~ ~.
"'
Ct /~~~~~ - ';
i9aa Jyn !~ rt'l Z~ kq
_ . ~ .~i , ~., ~ ..
"~
~
~
~
~
..
+
•, .
- : ~..
I FURTHEI? CERTIFY that I will regisier at my local acldreaa when the regiAiraiion 'txx~icc reopen.
.,• ., f ., 1°e31 r ~9: o.;± rf 1hi9 State.
un~l con;ptr ~:ith all o~h::r rcy;:.r~m.:.....s .. ..
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
in-__.__-_-- Ft. Fierce- -__. -- - --- -- -.. _
(City )
permanently.
~ ~'l
__-, ---Si~._ _Luci-e---------------- -- --- -- --County, Florida,
- ~ r
~-- /
>-L~'-- -- (/d="ray/'~----
(Name) ~~
_-,THt)'~f,AS_ CrABRIEL- CAMPBEI,L__ ..--_ ... ............
(Address )
Sworti~o 9nd uubk6i3ba~d-before me this_ ?A_ .. day of
,.
;-
7A~liJA)~1[,, ~ -;.-- #_--=---- - --- - -----., A. D. 19.61. .
'~ CIRC T COURT
-,t.o-~ -' - Dep. Clerk
(To be executed in duplicate aafd~riRinal Rled with Clerk Cireuit Court, and duplicate with Ta: Assessor)
t{r~v~'••rr tJrl !r [~I ~' i'O. I'Ip!1! 1117. FAA.
"'*Y